Transgender patients not electing as much gender-affirming surgery as many believe, study finds

Researchers from Boston Medical Center (BMC) have conducted the first study in the U.S. to determine the prevalence of gender affirming surgeries among a defined group of transgender patients, and found that most patients did not elect to have surgery. The study is published online in Endocrine Practice.

The study looked at 99 transgender patients who were undergoing hormone therapy at BMC, the majority transwomen. Data was collected from years prior to 2015, before Massachusetts required all insurers to cover medically necessary care related to gender transition, like gender affirming surgeries.

Only 35 percent of patients chose to undergo any form of gender affirming surgery, with only 15 percent undergoing genital surgery. Transmen were twice as likely to have surgery as transwomen, with more than half of transmen choosing to have chest surgery and far fewer choosing genital surgery. Transwomen were equally or less likely to undergo genital surgery than facial feminization or chest surgery.

"Before 2015, there was a much higher financial cost associated with this surgery," said Joshua Safer, MD, endocrinologist and medical director of the Center for Transgender Surgery and Medicine at BMC who led the study. "While accessibility has increased in the past decade, we still see a shortage of surgeons who perform gender affirming surgeries, and the data we have is limited."

BMC is the only academic medical center in Massachusetts, and one of few in the country, with a comprehensive transgender program including gender affirming surgery. BMC has a long history of providing a range of services to the transgender community including primary care, behavioral health and beyond. In 2016, BMC opened the Center for Transgender Medicine and Surgery which offers male-to-female genital surgery for adult transgender patients to meet the community's longstanding demand for access to comprehensive transgender medicine.

Researchers speculate that there will be an increase in gender-affirming surgeries in the future, and point to the need for better provider education in transgender medicine and further studies looking into how insurance coverage changes impact the number of transgender patients seeking out gender affirmation surgery.

"As of now, there are no nationally-representative data sets on the number of transmen and women who elect gender affirming surgery, and clinic-based data sets like BMC's can serve as a benchmark for future research," said Safer, who is also a professor of medicine at Boston University School of Medicine.

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